Amenable Mortality in Children under 5: An Indicator for Identifying Inequalities in Healthcare Delivery: A Review.

Universal health coverage has been proposed as a strategy to improve health in low- and middle-income countries, but this depends on a good provision of health services. Under-5 mortality (U5M) reflects the quality of health services, and its reduction has been a milestone in modern society, reducing global mortality rates by more than two-thirds between 1990 and 2020. However, despite these impressive achievements, they are still insufficient, and most deaths in children under 5 can be prevented with the provision of timely and high-quality health services. The aim of this paper is to conduct a literature review on amenable (treatable) mortality in children under 5. This indicator is based on the concept that deaths from certain causes should not occur in the presence of timely and effective medical care. A systematic and exhaustive review of available literature on amenable mortality in children under 5 was conducted using MEDLINE/PubMed, Cochrane CENTRAL, OVID medline, Scielo, Epistemonikos, ScienceDirect, and Google Scholar in both English and Spanish. Both primary sources, such as scientific articles, and secondary sources, such as bibliographic indices, websites, and databases, were used. Results: The main cause of amenable mortality in children under 5 was respiratory disease, and the highest proportion of deaths occurred in the perinatal period. Approximately 65% of avoidable deaths in children under 5 were due to amenable mortality, that is, due to insufficient quality in the provision of health services. Most deaths in all countries and around the world are preventable, primarily through effective and timely access to healthcare (amenable mortality) and the management of public health programs focused on mothers and children (preventable mortality).

A scale for measuring healthcare service quality incorporating patient-centred care and using a psychometric analytics framework.

PURPOSE: Recent developments in healthcare contexts increasingly emphasize patient-centred approaches to service quality measures; however, few studies consider this dimension explicitly. The present study develops and psychometrically validates a scale of healthcare service quality explicitly incorporating a patient-centred care dimension from a communicational perspective. The paper also enriches the traditional content of service quality by including equity items and presents the underlying structure of service quality in an emerging country. DESIGN/METHODOLOGY/APPROACH: The final sample consisted of 869 healthcare users (complete cases in the service quality items derived from 917 surveys received) from Colombia. The authors used a psychometric analytics framework comprising seven processes incorporating exploratory factor analysis, structural equation modelling, and machine learning methods to examine construct plausibility, reliability, construct validity, equity, and criterion/predictive validity (e.g. explaining/predicting subjective well-being and behavioural intentions). FINDINGS: The final scale consists of 17 items and satisfies all psychometric properties. Its validation allows for the discovery and psychometrical confirmation of two essential dimensions: patient-centred communication (eight items) and process quality (nine items). PRACTICAL IMPLICATIONS: The authors illustrate three practical uses of the scale: the possibility for diagnoses; hypothesis contrast based on confidence intervals; and estimation of the capacity of the service to satisfy specifications. ORIGINALITY/VALUE: Both dimensions reveal users' relevant needs and complement previous studies that have focused on process aspects of healthcare service quality.

Análise da correlação dos índices de estrutura e recursos humanos do serviço veterinário oficial em 2019 e as incidências acumuladas (2017 ­ 2019) de doenças de notificação obrigatória em bovinos e equinos no Brasil / Analysis of the correlation between the structure and human resources indexes of the official veterinary service in 2019 and the accumulated incidences (2017 ­ 2019) of notifiable diseases in cattle and horses in Brazil

As doenças de notificação obrigatória em bovinos podem gerar impactos sociais e econômicos significativos na cadeia pecuária brasileira, além de consequências negativas no mercado internacional devido a embargos sanitários. Para auxiliar no entendimento de como um sistema de vigilância epidemiológica com mais recursos pode gerar mais credibilidade para o país, foram realizadas análises de correlação entre a notificação de doenças e a estrutura veterinária disponível nos Órgãos Executores de Sanidade Agropecuária (OESAs), a partir dos dados contidos no Sistema Nacional de Informação Zoossanitária (SIZ), entre os anos de 2017 e 2019. Com base nos dados do serviço veterinário, foram produzidos o Índice de Estrutura Física Oficial (IEFO) e o Índice de Recursos Humanos do Serviço Oficial (IRHSO). Foi realizada análise de correlação entre a notificação de doenças de bovinos com a capacidade de estrutura física e recursos humanos de vigilância epidemiológica disponíveis no Serviço Veterinário brasileiro. Os estados AP, RR e SC foram os que mais notificaram brucelose e tuberculose no período e estão entre os melhores índices de estrutura e recursos humanos do país. A análise dos índices mostrou que a raiva não possui correlação significativa com estrutura e recursos humanos do serviço, entretanto, brucelose e tuberculose possuem correlação positiva com estrutura veterinária oficial disponível para a vigilância em bovinos. Portanto, melhorias na estrutura podem refletir no incremento dos índices de notificação das doenças de bovinos, assim como na qualidade de suas informações.

Notifiable diseases in cattle can generate significant social and economic impacts on the Brazilian livestock chain, in addition to impacts on the international market due to sanitary embargoes. To help understand how an epidemiological surveillance system with more resources can generate more credibility for the country, correlation analyzes were carried out between the notification of diseases and the veterinary structure available in the Executing Bodies of Agricultural Health (OESAs), based on the data contained in the National System of Zoosanitary Information (SIZ), between the years 2017 to 2019. Based on public data from the veterinary service, the Official Physical Structure Index (IEFO) and the Official Service Human Resources Index (IRHSO) were produced. Correlation analysis was performed between the notification of bovine diseases with the capacity of physical structure and human resources for epidemiological surveillance available in the Brazilian Veterinary Service. AP, RR and SC were the states that most notified brucellosis and tuberculosis in the period and are among the best indices of structure and human resources in the country. The analysis of correlation indices showed that the rabies disease does not have a significant correlation with the structure and the human resources of the service, however, brucellosis and tuberculosis does have a positive correlation with the official veterinary structure available for surveillance in cattle. Therefore, Improvements in the structure can reflect in the increase of the notification rates, as well as in the quality of its information.

Evaluación psicométrica de la escala de calidad de servicios de atención en donantes de un banco de sangre en Medellín, Colombia, 2019 / Psychometric assessment of a quality scale perceived in blood bank donors of Medellín, Colombia, 2019 / Avaliação psicométrica de uma escala de qualidade percebida em doadores de um banco de sangue em Medellín, Colômbia, 2019

Resumen Objetivo: Evaluar la adaptabilidad del modelo Service Quality (servqual), con el fin de valorar la calidad del servicio en la atención de los donantes de un banco de sangre en la ciudad de Medellín. Metodología: Se llevó a cabo una evaluación psicométrica en 301 donantes de sangre, para determinar la calidad percibida. Se realizaron pruebas de consistencia interna con alpha de Cronbach e índice de discriminación, y se evaluó la validez de contenido de los dos cuestionarios y la estructura factorial, mediante análisis factorial exploratorio. Resultados: El alpha de Cronbach fue de 0,86; en las subescalas de expectativas, 0,87, y en percepciones, 0,77. Se observó una mayor consistencia interna en el cuestionario de expectativas que de percepciones. Aunque se obtuvo una baja consistencia interna en algunas dimensiones, no se afecta la escala de manera global. Conclusión: La escala servqual presenta un adecuado desempeño psicométrico y, por tanto, es útil para evaluar la calidad percibida en la atención en donantes de sangre, siempre y cuando sea abordada de forma unidimensional.

Abstract Objective: To assess the reproducibility and validity of the scale of perceived quality in donors from a blood bank in the city of Medellín. Methodology: Psychometric evaluation in 301 blood donors through internal consistency with Cronbach's alpha and discrimination index. Content validity of the polls and factorial structure were evaluated by means of exploratory factor analysis. Results: Cronbach's alpha was 0.86. For the expectations subscales, 0.87 and in perceptions 0.77. A greater internal consistency was observed in the poll of expectations rather than in that of perceptions. Although low internal consistency was obtained in some dimensions, this does not affect the scale globally. The use of the instrument should be approached in a unidimensional way. Conclusion: The servqual scale presents an adequate psychometric performance and, therefore, is useful to assess the perceived quality of care in blood donors in the Colombian context, as long as it is approached in a unidimensional way.

Resumo Objetivo: Avaliar a reprodutibilidade e validade da escala de qualidade percebida em doadores de um banco de sangue da cidade de Medellín. Metodologia: Avaliação psicométrica em 301 doadores de sangue, por meio da consistência interna com Alfa de Cronbach e índice de discriminação. A validade do conteúdo dos questionários e a estrutura fatorial foram avaliadas por meio de análise fatorial exploratória. Resultados: O Alfa de Cronbach foi de 0,86, nas subescalas de expectativas 0,87 e nas percepções 0,77. Foi observada maior consistência interna no questionário de expectativas do que de percepções. Embora tenha sido obtida baixa consistência interna em algumas dimensões, isso não afeta a escala globalmente; a utilização do instrumento deve ser abordada de uma forma unidimensional. Conclusão: A escala servqual apresenta um desempenho psicométrico adequado e, portanto, é útil para avaliar a percepção da qualidade do cuidado em doadores de sangue no contexto colombiano, desde que seja abordada de uma forma unidimensional.

La relación entre la calidad en el servicio, satisfacción del cliente y lealtad del cliente: un estudio de caso de una empresa comercial en México / The relationship between service quality, customer satisfaction, and customer loyalty: A case study of a trading company in Mexico

Resumen La calidad en el servicio se considera una alternativa para que las empresas puedan obtener una ventaja competitiva y sostenible en un entorno económico globalizado. Las pequeñas y medianas empresas deben ofrecer una mayor calidad en el servicio que las empresas grandes, y así obtener la preferencia de los clientes. El objetivo de este estudio fue identificar la relación entre la variable calidad en el servicio y las variables satisfacción del cliente y lealtad del cliente. Se utilizó el coeficiente de correlación de Spearman y un método estadístico basado en análisis factorial exploratorio que apunta a extraer la varianza máxima del conjunto de datos dentro de cada factor. Los resultados permitieron observar una correlación altamente significativa, positiva y fuerte de la variable de calidad en el servicio con satisfacción del cliente (r = 0.820) y lealtad del cliente (r = 0.803). Un hallazgo importante también fue la asociación entre la dimensión aspectos tangibles con las variables satisfacción del cliente (r = 0.910) y lealtad del cliente (r = 0.919). Por otro lado, en el análisis factorial, a través de la varianza total explicada, se observó que el autovalor es superior a 1 en los cinco primeros casos, donde el porcentaje de la varianza alcanza un valor máximo de 54.886 % en su primer factor. Entonces, con cinco factores se consigue explicar un 73.713 % de la varianza de todos los datos originales. El estudio presentó la limitación de su aplicación en solo una empresa. Se confirmó que a través de una mejor atención y servicio al cliente, la calidad en el servicio constituye una excelente herramienta para la rentabilidad y sostenibilidad de la empresa.

Abstract Service quality is considered an alternative for companies to obtain a competitive and sustainable advantage in a globalized economic environment. Small and medium-sized enterprises must offer a higher quality of service than large companies, and thus obtain customer preference. The objective of this study was to identify the relationship between service quality variable and the customer satisfaction and customer loyalty variables. Spearman's correlation coefficient was used, and a statistical method based on exploratory factor analysis, aiming to extract the maximum variance of the data set within each factor. The results allowed observing a highly significant, positive, and strong correlation, with values of r = 0.820 and r = 0.803, between the variables of service quality, customer satisfaction, and customer loyalty. An important finding was the association between the tangible aspects dimension with the customer satisfaction and customer loyalty variables, with values of r = 0.910 and r = 0.919, respectively. On the other hand, in the factor analysis, through the explained total variance, it was observed that the eigenvalue is greater than 1 in the first five cases, where the percentage of the variance reaches a maximum value of 54.886 % in its first factor. Then, with five factors, 73.713 % of the variance of all the original data is explained. The study presented the limitation of its application in only one company. It was confirmed that, through better customer care and service, service quality constitutes an excellent tool for the profitability and sustainability of the organization.

Improving service performance in organizations for individuals with intellectual disability: an intervention focused on participation of families / A melhoria do desempenho do serviço em organizações para indivíduos com deficiência intelectual: uma intervenção com foco na participação das famílias / La mejora del desempeño del servicio en organizaciones para personas con discapacidad intelectual: una intervención centrada en la participación de las familias

To improve service performance in organizations for individuals with intellectual disability, the authors tested an intervention based on collaborative teams. Specifically, professionals and families cooperated in the design and implementation of projects to improve the quality of life of individuals with intellectual disability. We considered two service performance indicators reported by family members (N = 342; 78% women; and a mean age of 57.17 years): service quality and self-determination communication openness. Our results revealed that family members assigned to the experimental condition improved their service quality evaluations from pre-intervention to post-intervention, whereas family members assigned to the control condition did not change their evaluations. The intervention was not effective for communication openness. Perceptions remained stable in family members who participated in the teams (experimental condition), whereas communication openness decreased in family members in the control condition. We discuss the implications of our findings for service research.

Para melhorar o desempenho do serviço em organizações para indivíduos com deficiência intelectual, os autores testaram uma intervenção baseada em equipes colaborativas. Especificamente, profissionais e famílias cooperaram na concepção e implementação de projetos para melhorar a qualidade de vida das pessoas com deficiência intelectual. Foram considerados dois indicadores de desempenho do serviço relatados pelos familiares (N = 342; 78% mulheres; idade média de 57,17 anos): qualidade do serviço e abertura de comunicação autodeterminada. Nossos resultados revelaram que os membros da família atribuídos à condição experimental melhoraram suas avaliações de qualidade de serviço de pré-intervenção para pós-intervenção, enquanto os membros da família atribuídos à condição de controle não mudaram suas avaliações. A intervenção não foi eficaz para a abertura de comunicação. As percepções permaneceram estáveis ​​nos familiares que participaram das equipes (condição experimental), enquanto a abertura comunicativa diminuiu nos familiares na condição controle. Discutimos as implicações de nossas descobertas para a pesquisa de serviços.

Para mejorar el desempeño del servicio en organizaciones para personas con discapacidad intelectual, los autores pusieron a prueba una intervención basada en equipos colaborativos. En concreto, profesionales y familias colaboraron en el diseño e implementación de proyectos para mejorar la calidad de vida de las personas con discapacidad intelectual. Se consideraron dos indicadores de desempeño del servicio reportados por los miembros de la familia (N = 342; 78% mujeres; y una edad promedio de 57,17 años): calidad del servicio y apertura en comunicación sobre autodeterminación. Nuestros resultados revelaron que los miembros de la familia asignados a la condición experimental mejoraron sus evaluaciones de calidad del servicio desde la preintervención hasta la postintervención, mientras que los miembros de la familia asignados a la condición de control no cambiaron sus evaluaciones. La intervención no fue eficaz para la apertura en comunicación. Las percepciones se mantuvieron estables en los familiares que participaron en los equipos (condición experimental), mientras que la apertura en comunicación disminuyó en los familiares en la condición de control. Se analizan las implicaciones de nuestros hallazgos para la investigación de servicios.

The Influence of Emotion in the Management of Amateur Football Organizations.

This article is oriented to the analysis of organizational and emotional variables in amateur sporting organizations. The general objective is to analyze the influence of organizational variables such as service quality, transactional leadership, and transformational leadership and emotional variables such as affective commitment, emotional attachment investment, and emotional attachment dividend to predict the credibility that members of amateur sporting organizations perceive, as well as their degree of identification and loyalty. The opinions of 203 members of Chilean amateur football teams [169 men and 34 women, with ages between 18 and 68 years (mean = 32.75 years, DT = 9.92)] have been analyzed through a self-completed questionnaire. To reach the objectives, two types of differential but complementary analyses, in the form of hierarchical regression models (from hereon, HRMs) and qualitative comparative analysis (from hereon, QCA), were performed. The results obtained suggest that the organizational variables are better predictors than the emotional variables in all of the cases. In the same way, the inclusion of the emotional variables improves the predictive capacity of the proposed models to explain identification and loyalty, but not in the case of credibility. In general, the variables considered seem to explain 37% of the credibility, 56% of loyalty, and 65% of identification. On the other hand, considering the results of the QCA, no variable turned out to be necessary. However, different combinations of variables (conditions) were observed that were able to explain between 47 and 91% of the cases of the variables analyzed. In general, based on these results, it was observed that the emotional variables were important in interaction with other organizational ones since they are present in the three combinations that most explain identification and loyalty and are also present in the three combinations that most explain credibility. This study contributes to the literature by supporting the importance of managing emotions in order for sporting organizations to be more successful.

Patient Satisfaction in the Peruvian Health Services: Validation and Application of the HEALTHQUAL Scale.

During recent years, public-private partnerships (PPPs) in the health sector have been an attractive alternative for improving healthcare services in developing countries such as Peru. Therefore, it is fundamental to consider a comprehensive set of healthcare qualities, like the HEALTHQUAL scale, when we measure dimensions of healthcare service quality. Currently, no studies have applied HEALTHQUAL in Peruvian hospitals. The purposes of this study were to (1) validate and evaluate the application of the HEALTHQUAL scale to measure user satisfaction in outpatient services at two PPP hospitals in Peru; and (2) test the relationship between user satisfaction, efficiency, and loyalty. A descriptive, cross-sectional study based on the HEALTHQUAL scale was carried out at the end of 2018. The measurement items were satisfaction with healthcare personnel, satisfaction with nonhealthcare personnel, satisfaction with facilities and equipment, perception of efficiency, and trust. The scale was administered to a nonprobability sample of 250 users who attended one of two PPP hospitals-Barton and Kaelin. The application of partial least squares path modeling significantly impacted on the perceived efficiency in the items of healthcare personnel, nonhealthcare personnel, and facilities and equipment. The HEALTQUAL scale demonstrated sufficient validity and thus can be applied for measuring user satisfaction in PPP hospitals.

Corrida de São João de Braga: qualidade de serviços e intenções de recomendação dos participantes / São João de Braga running: service quality and intention of recommendation from participants / Carrera de São João de Braga: calidad de servicios e intenciones de recomendación de los participantes

O objetivo deste estudo passou pela análise da qualidade dos serviços e a consequente intenção de recomendação da corrida de São. João de Braga e da região de Braga, como destino turístico, por parte dos participantes. A amostra foi de 284 participantes, tendo sido usado um instrumento que já foi utilizado noutros estudos desta mesma temática. Para analisar os dados e verificar a relação existente entre as variáveis foram realizados testes de regressão linear múltipla. Os principais resultados evidenciaram o processo de acreditação e o kit de participação como preditores estatisticamente significativos ao nível das intenções de recomendação da corrida e o processo de acreditação e a paisagem circundante para as intenções de recomendação da região. Posto isto, aquando da avaliação da qualidade dos serviços, destaca-se o processo de acreditação, uma vez que é um preditor comum das intenções de recomendação do evento e da região.

The aim of this study was to analyze the quality of services and the consequent intention of recommending the race of São João de Braga and the region of Braga, Portugal, as a tourist destination, by the participants. The sample consisted of 284 participants, using an instrument that has already been used in other studies of this same subject. To analyze the data and verify the relationship between the variables, multiple linear regression tests were performed. The main results evidenced the accreditation process and the participation kit as statistically significant predictors in the intentions of the race recommendation and the accreditation process and the surrounding landscape for the region's recommendation intentions. In conclusion, when assessing the quality of services, the accreditation process stands out, since it is a common predictor of the intentions of the event and the region

El objetivo de este artículo es analizar la calidad de los servicios y la consecuente recomendación de la carrera de São João de Braga y la región de Braga, Portugal, como destino turístico, por parte de los participantes. Una muestra de 284 participantes, se usó un instrumento ya utilizado de otros instrumentos de estudio de la temática. Para análisis de datos y verificación de la relación existente, se han realizado varios ensayos de regresión lineal. Los principales resultados son la evidencia o el proceso de acreditación y el kit de participación como predictores estadísticamente significativos a lo largo de las intenciones de recomendación y el proceso de acreditación y la distribución de datos para las intenciones de recomendación. En conclusión, el aval da evaluación da calidad dos servicios, destaca-se el proceso de acreditación, es posible que sea su predictor común das intenciones de recomendación do evento y da región.

Análisis de la calidad de los servicios académico-administrativos en una universidad colombiana / Analysis of the quality of academic-administrative services in a Colombian university / Análise da qualidade dos serviços académico-administrativos em uma universidade colombiana

Resumen Introducción. En este artículo se presentan los resultados finales de la investigación Análisis de la calidad de los servicios académico-administrativos en una universidad colombiana. Objetivo. Determinar la percepción de los estudiantes respecto a los servicios ofrecidos. Materiales y Métodos. Se utilizó el instrumento Servqualing aplicándose a una muestra de 832 estudiantes los cuales fueron seleccionados por el método sistemático. Se realizó Análisis de Factores. Resultados. El análisis arrojó tres dimensiones con 61,39 % de la varianza explicada, KMO=0,973 y un determinante de 0,01325. La confiabilidad del instrumento de medición usando Alpha de Cronbach fue de 0,949, indicando una alta fiabilidad de la escala y validez interna y externa obtenida con pruebas estadísticas significativas al 5 %. Conclusiones. Los resultados evidencian que el nivel de calidad global de los servicios académico administrativos, tienen una Buena, percepción con una calificación de 4,08 (80 %), indicando que los mejores resultados se encontraron en los ítems asociados con la dimensión 3 y con oportunidades de mejora principalmente en la dimensión 1. Estos resultados permiten orientaciones precisas para la toma de decisiones y conllevan al mejoramiento continuo de la calidad del servicio.

Abstract Introduction. This article shows the final results of the research "Analysis of the quality of academic-administrative services in a Colombian university". Objective. Determine the perception of students regarding the services offered. Materials and Methods. For the measurement, the Servqualing instrument was applied to a sample of 832 students who were selected by the systematic method. Results. A factor analysis was carried out which showed three dimensions with 61.39% of the variance explained, KMO = 0.973 and a determinant of 0.01325. The reliability of the measuring instrument using Cronbach's Alpha was 0.949, indicating a high reliability of the scale, and internal and external validity was obtained with significant statistical tests at 5%. Conclusions. The results show that the overall quality level of academic administrative services has a good perception with a score of4.08 (80%), indicating that the best results were found in the items associated with dimension 3 and with opportunities for improvement, mainly in dimension 1. These results allow precise guidelines for decision making and lead to continuous improvement of service quality.

Resumo Introdução. Neste artigo apresenta-se os resultados finais da pesquisa Análise da qualidade dos serviços académico-administrativos em uma universidade colombiana. Objetivo. Determinar a percepção dos estudantes respeito aos serviços oferecidos. Materiais e Métodos. Utilizou-se o instrumento Servqualing aplicando-se em uma amostra de 832 estudantes os quais foram selecionados pelo método sistemático. Realizou-se Análise de Fatores. Resultados. O análise mostrou três dimensões com 61,39 % da variância explicada, KMO=0,973 e um determinante de 0,01325. A confiabilidade do instrumento de medição usando Alpha de Cronbach foi de 0,949, indicando uma alta fiabilidade da escala e validez interna e externa obtida com provas estatísticas significativas ao 5 %. Conclusões. Os resultados evidenciam que o nível de qualidade global dos serviços académico-administrativos, tem uma Boa, percepção com uma qualificação de 4,08 (80%), indicando que os melhores resultados se encontraram nos itens associados com a dimensão 3 e com oportunidades de melhora principalmente na dimensão 1. Estes resultados permitem orientações precisas para a toma de decisões e acarreiam ao melhoramento contínuo da qualidade do serviço.

Exploring the nonlinear impact of critical incidents on users' satisfaction with healthcare services.

PURPOSE: The purpose of this paper is to evaluate the nonlinear impact of users' memories on their general evaluation of outpatient healthcare services by the integration of two methodologies: critical incidents technique (CIT) and penalty-reward contrast analysis (PRCA). DESIGN/METHODOLOGY/APPROACH: The authors carried out a survey with 356 respondents, users of seven outpatient clinics located in the city of Blumenau/SC, Brazil, during 2016. The participants were asked about their perceptions of positive and negative aspects of the service; and, using CIT, the answers were categorized according to the following dimensions: empathy, communication, facilities, access, promptness, medicines availability, complementary services, safety/confidentiality and service performance. Then, the authors evaluated the nonlinear impact of critical incidents on users' general evaluation of the service using the identified incidents as input variables in a PRCA. FINDINGS: The findings show that users of healthcare services tend to remember emotion and health aspects positively, while technical and formal aspects tend to be more negatively than positively remembered. On the other hand, PRCA identifies that incidents of three dimensions positively influence the overall perception of the service (empathy, complementary services and privacy) and five negatively (empathy, facilities, speed, drugs/pharmacy and health performance), explaining 26.3 percent of the variation in clients' general satisfaction. ORIGINALITY/VALUE: The present paper explores the integration of two methodologies, showing how we can use open listening to healthcare service users to identify the nonlinear impact of different incidents on their general evaluation of the service. The results show that what customers remember does not necessarily influence overall customer satisfaction. The present approach allows companies to improve the process of listening to customers. There are no other papers exploring this approach, particularly in relation to healthcare services.

Factores explicativos de la preferencia y uso de la administración electrónica en España / Fatores explicativos da preferência e uso da administração eletrônica na Espanha / Explanatory factors of the preference and use of electronic administration in Spain

Resumen En la actualidad, muchos gobiernos ofrecen a sus ciudadanos servicios públicos a través de internet (administración electrónica). En este trabajo se analizan tres factores que podrían explicar el uso de la administración electrónica: perfil sociodemográfico de los ciudadanos, niveles de calidad de los servicios públicos ofrecidos por ese medio y grado de satisfacción de los ciudadanos con esos servicios. Los resultados ponen de manifiesto que los ciudadanos que prefieren utilizar internet como medio de contacto o que utilizan la administración electrónica se caracterizan por ser personas jóvenes, con estudios universitarios o estudiantes. En cambio, las personas que no utilizan la administración electrónica o que prefieren el canal presencial son mayoritariamente personas mayores con estudios primarios. En segundo lugar, a pesar de que los ciudadanos perciban una alta calidad y tengan un alto grado de satisfacción con esos servicios públicos, esto no resulta en altas tasas de uso de la administración electrónica. Por último, para incrementar el uso de la administración electrónica es primordial la utilización de interfaces sencillas, intuitivas y fáciles de usar por cualquier persona, especialmente por personas mayores y con estudios primarios.

Resumo Atualmente, muitos governos oferecem aos seus cidadãos serviços públicos por meio da internet (governo eletrônico). Este artigo analisa três fatores que poderiam explicar o uso do governo eletrônico: perfil sociodemográfico dos cidadãos, níveis de qualidade dos serviços públicos oferecidos por esse meio e grau de satisfação dos cidadãos com esses serviços. Os resultados mostram que os cidadãos que preferem usar a internet como meio de contato ou que usam o governo eletrônico são caracterizados por serem jovens, com estudos universitários ou estudantes. Por outro lado, aquelas pessoas que não usam administração eletrônica ou que preferem o canal face a face são, em sua maioria, pessoas idosas com educação primária. Em segundo lugar, embora os cidadãos percebam uma alta qualidade e tenham um alto grau de satisfação com esses serviços públicos, isso não se traduz em altas taxas de uso de governo eletrônico. Finalmente, a fim de aumentar o uso da administração eletrônica, o uso de interfaces simples, intuitivas e de fácil utilização é essencial, especialmente para os idosos e com o ensino primário.

Abstract Currently, many governments offer their citizens public services through the internet (eGovernment). This article analyzes three factors that could explain the use of eGovernment: sociodemographic profile of citizens, levels of quality of public services offered in this way, and the degree of citizen satisfaction with these services. The results show that citizens who prefer to use the internet as a means of contact or who use eGovernment are characterized as being young people, undergraduate students or with a university degree. On the other hand, those who do not use electronic administration or who prefer the face-to-face channel are mostly elderly people or those with basic education. Secondly, although citizens perceive a high quality and have a high degree of satisfaction with these public services, this does not translate into high rates of use of eGovernment. Finally, increasing the use of electronic administration implies in using simple, intuitive and user-friendly interfaces, especially targeting the elderly and those with basic education.

Service quality for continuing higher education in online learning environments / Calidad del servicio para la educación superior contínua en entornos virtuales de aprendizaje / Qualidade de serviço para ensino superior contínuo em ambientes virtuais de aprendizagem

ABSTRACT This paper aims to identify the factors that influence the perceived quality of service for continuing higher education in online learning environments. To that end, a quantitative descriptive study, which was applied to 4,735 students in continuing higher education courses, who were given a self-administered scale online. The instrument was constructed considering the following factors: teaching skills, teachers' attitudes and behavior administrative and support team, the navigation platform, curricula, and the organization of courses for continuing education. The results show that the scale of perceived service quality for continuing virtual education from the students' perspective is a two-dimensional construct. The first factor includes administrative support, content, educational aspects, and the interface, which constitute virtual education facilitators. The second factor involves the teaching skills necessary to guide a online learning course. The findings contribute to decisions in the management and development of continuing online learning, whose growing demand warrants a review of ways to satisfy users, allowing the modality to be viewed with a more positive perception. JEL CLASSIFICATION: 21, M30.

RESUMEN Este estudio tiene como objetivo identificar los factores que influyen en la calidad de servicio percibida para la educación superior continua en entornos de aprendizaje virtuales. Con ese fin, se realizó un estudio cuantitativo descriptivo, con una muestra de 4,735 estudiantes de cursos de educación superior continua, a los que se les aplicó un cuestionario en línea. El instrumento se construyó teniendo en cuenta los siguientes factores: habilidades de enseñanza, actitudes y comportamiento de los maestros, equipo administrativo y de apoyo, la plataforma de navegación, planes de estudio y la organización de cursos para la educación continua. Los resultados muestran que la escala de calidad de servicio percibida para la educación virtual continua desde la perspectiva de los estudiantes es una construcción bidimensional. El primer factor incluye el apoyo administrativo, el contenido, los aspectos educativos y la interfaz, que constituyen facilitadores de la educación virtual. El segundo factor involucra las habilidades de enseñanza necesarias para guiar un curso de aprendizaje en línea. Los hallazgos contribuyen a las decisiones en la gestión y el desarrollo del aprendizaje en línea continuo, cuya creciente demanda justifica una revisión de las formas de satisfacer a los usuarios, lo que permite ver esta modalidad de aprendizaje con una percepción más positiva. CÓDIGOS JEL: 21, M30.

RESUMO O objetivo deste estudo é identificar os fatores que influenciam a qualidade de serviço percebida para o ensino superior continuado em ambientes virtuais de aprendizagem. Para tanto, foi realizado um estudo quantitativo descritivo, com uma amostra de 4.735 estudantes de cursos superiores de ensino superior aos quais foi aplicado um questionário online. O instrumento foi construído considerando os seguintes fatores: habilidades de ensino, atitudes e comportamento dos professores, equipe administrativa e de apoio, plataforma de navegação, planos de estudo e organização de cursos para educação continuada. Os resultados mostram que a escala de qualidade de serviço percebida para a educação virtual na perspectiva dos estudantes é uma construção bidimensional. O primeiro fator inclui suporte administrativo, conteúdo, aspectos educacionais e a interface, que são facilitadores da educação virtual. O segundo fator envolve as habilidades de ensino necessárias para orientar um curso de aprendizado on-line. Os achados contribuem para as decisões na gestão e desenvolvimento da aprendizagem online contínua, cuja demanda crescente justifica uma revisão das formas de satisfação dos usuários, o que nos permite enxergar essa modalidade de aprendizagem com uma percepção mais positiva. CLASSIFICAÇÕES JEL: 21, M30.

A segurança do paciente no contexto hospitalar: desvelando fatores intervenientes à assistência na percepção de enfermeiros / Patient safety in the hospital context: unveiling involved factors related to healthcare from the point of view of nurses

Introdução: Os fatores que condicionam e determinam a prestação de cuidados em saúde vêm recebendo destaque nos dias atuais, considerando os seus impactos sociais e sanitários. Objetivo: Identificar a percepção de enfermeiros acerca do significado de segurança e qualidade na assistência à saúde e descrever o conhecimento de enfermeiros sobre as fragilidades e potencialidades para a prestação da assistência segura e de qualidade a pacientes adultos hospitalizados. Método: Trata-se de uma pesquisa exploratória, descritiva e de abordagem qualitativa. Os dados foram coletados através de questionário aplicado a enfermeiros de um hospital geral público do Rio de Janeiro. Para análise dos dados se utilizou da Análise Temática de Conteúdo de Minayo. Resultados: A partir da análise de conteúdo, os fatores condicionantes foram desvelados em três categorias: "Percepção dos enfermeiros sobre a Segurança e Qualidade da Assistência"; "Fragilidades e potencialidades para a Segurança do Paciente" e "Sugestões para a melhoria da qualidade e segurança do cuidado". Conclusões: Os enfermeiros assistenciais detêm compreensão adequada sobre a qualidade e segurança no cuidado e possuem conhecimentos sobre ações interventivas de diferentes níveis de governabilidade para abordagem das fragilidades e do fortalecimento das potencialidades, sendo, portanto, conveniente, que participem do processo decisório nos serviços.

Introduction: The factors that influence and determine the provision of health are highlighted nowadays, considering their social and health impacts. Objective: To identify the perception of nurses about the meaning of safety and quality in healthcare and to describe the knowledge of nurses about the weaknesses and potentialities to deliver safe and high-quality care to hospitalized adult patients. Method: This is an exploratory, descriptive and qualitative research. Data were collected by questionnaire applied to nurses of a public general hospital in Rio de Janeiro and analyzed using thematic analysis of content by Minayo. Results: From the content analysis, the conditioning factors were unveiled in 03 categories: "Nurses' Perception of Safety and Quality of Care," "Weaknesses and potentialities for Patient Safety," and "Suggestions for Improving Quality and Safety of Care." Conclusions: Care nurses have adequate understanding about the quality and safety of assistance and have knowledge of intervention actions of different levels of governance to address weaknesses and strengthening of potentialities and, therefore, they should be involved in the decision-making process in the organizations.

Efecto de los aspectos demográficos en la valoración de la calidad del servicio: una revisión / Effect of the demographic aspects in the valuation of the quality of the service: a review

Comprender los elementos que determinan la satisfacción de usuarios o de clientes de un servicio permite a las organizaciones -tanto públicas como privadas- diseñar e implementar estrategias dirigidas a mejorar los niveles de lealtad y de recompra, entre otras intenciones futuras. Este artículo tiene como propósito evidenciar el efecto que tienen las variables demográficas, como elementos o constructos determinantes de la calidad de un servicio. Para lograr este cometido, se han tenido en cuenta artículos de investigación publicados en revistas indexadas en Scopus, Science Direct y Ebsco Host, durante el periodo 2006-2016, referentes a casos empíricos, donde se analizaron las relaciones de las variables demográficas sobre constructos, que caracterizan la calidad del servicio. La revisión permitió evidenciar la existencia de efectos, positivos o negativos, de los aspectos demográficos de los clientes o consumidores, sobre las expectativas, las percepciones, la satisfacción y las intenciones futuras, siendo el género, la edad, los ingresos y el nivel de estudios, las variables con mayores incidencias.

Understanding the elements affecting the satisfaction of users and customers of a service enable organizations to conduct actions and strategies focused in performance the levels of loyalty and repurchase, among other future behaviour. The purpose of this article is to evidence the demographic variables effect, as one of the factors or constructs which could become an important determinant of the service quality. To achieve this purpose were taken into account papers published in the last 10 years, that included into an empirical case, some demographics variables. As result from this analisys, was evidenced effects -positives or negatives- from the demographics elements over the expectatives, perceptions, satisfaction and future behaviour, being the gender, age, income, and study level the variables with the most incidences.

Service quality in public health clinics: perceptions of users and health professionals.

Purpose The purpose of this paper is to investigate the expectations and quality gaps in services provided at city public health clinics in the city of Natal, Brazil, from the perspective of patients and healthcare service providers. Design/methodology/approach The research sample consisted of 1,200 patients who used public health services and 265 providers - doctors, nutritionists, physiotherapists, psychologists, pharmacists and managers at three health clinics in the city of Natal, Brazil. A scale with 25 health service attributes was used in data collection. Summary statistics and t-test were used to analyze the data. Findings The results show that the providers think that users have lower levels of expectations than those indicated by the users in all attributes. Providers and users have the most approximate insights into what attributes are considered most important: explanations, level of knowledge and attention dispensed by health professionals. Users and providers perceived similar quality gaps for most of the attributes. The gaps were statistically the same, when comparing the mean quality shortcomings by means of a Student's test, considering a significance level of 5 percent, obtained independently by the manifestation of users and providers. Research limitations/implications The results reveal only a photograph of the moment. The study did not consider the differences that may exist between groups with different income levels, genders or age groups. A qualitative study could improve the understanding of the differences and coincidences of the diverse points of views. A more advanced research could even study possibilities so that health managers could promote changes in the service, some of them low cost, as the health professionals training for contact with patients. Practical implications The evaluation of the service quality complemented by the matrix of opportunities, importance × quality gaps generates information to help make decisions in the rational allocation of available resources and improvement of the quality of the service delivered to patients. Besides, it offers a focus to prioritize specific actions. Originality/value It is important to compare the perceptions of service quality between patients and the healthcare service providers who work in direct contact with them. The managers can smooth out these differences and ensure, over time, customer satisfaction. In this study, providers were asked to express what they think about the expectations of patients and about their own service performance delivered. Thus, not only the traditional gap 5 was measured, but it was also possible to evaluate the distance between what providers think that patients need and their actual needs.

Impact of regulation on English and Welsh water-only companies: an input-distance function approach.

The assessment of productivity change over time and its drivers is of great significance for water companies and regulators when setting urban water tariffs. This issue is even more relevant in privatized water industries, such as those in England and Wales, where the price-cap regulation is adopted. In this paper, an input-distance function is used to estimate productivity change and its determinants for the English and Welsh water-only companies (WoCs) over the period of 1993-2009. The impacts of several exogenous variables on companies' efficiencies are also explored. From a policy perspective, this study describes how regulators can use this type of modeling and results to calculate illustrative X factors for the WoCs. The results indicate that the 1994 and 1999 price reviews stimulated technical change, and there were small efficiency gains. However, the 2004 price review did not accelerate efficiency change or improve technical change. The results also indicated that during the whole period of study, the excessive scale of the WoCs contributed negatively to productivity growth. On average, WoCs reported relatively high efficiency levels, which suggests that they had already been investing in technologies that reduce long-term input requirements with respect to exogenous and service-quality variables. Finally, an average WoC needs to improve its productivity toward that of the best company by 1.58%. The methodology and results of this study are of great interest to both regulators and water-company managers for evaluating the effectiveness of regulation and making informed decisions.

Percepción usuaria de la calidad en los servicios de salud del ISSEMyM / User perception of the quality in health services of the ISSEMyM / Percepção do usuário sobre a qualidade dos serviços de saúde ISSEMyM / Perception des usagers sur la qualité des services de santé du ISSEMyM

Resumen Objetivo: Conocer la perspectiva de los derechohabientes con respecto a la calidad en el servicio de salud que brinda el Instituto de Seguridad Social del Estado de México y Municipios (ISSEMyM). No coincide con el que dice en el texto. Materiales y métodos: Se realizó un estudio descriptivo mediante la aplicación de la Escala de Calidad del servicio recibido en Derechohabientes (ECALDER) a 355 personas que tenían al menos un año con el beneficio asistencial dentro de los 10 diferentes centros del Instituto ISSEMyM. Resultados: La insatisfacción con la calidad de los servicios es reportada con puntajes bajos (Percentil 36.79). El análisis correlacional arrojó puntajes bastante significativos (p < 0.00) lo que indicó la inter-relación de las percepciones del trato con el personal, elaboración de trámites y confianza en la institución. Conclusiones: Desde un análisis factorial, los aspectos de trámites y confianza en la institución son los mejores evaluados, seguido de la interacción con el personal; correlacionalmente, la interacción con el personal de cualquier área, influencia la percepción hacia otras, mientras que la confianza en la institución. depende de la percepción del personal de enfermería y trámites.

Abstract Objective: To determine the perspective of the beneficiaries regarding the quality of health service provided by the Instituto de Seguridad Social del Estado de México y Municipios (ISSEMyM). Materials and methods: Through a descriptive study which contemplates the application of the Scale of Quality Service in ISSEMyM Beneficiaries (ECALDER, Quality Scale of receiving service in users) to 355 beneficiaries who at least had one year with the assistance benefit within 10 different centers of the Institute. Results: The dissatisfaction with the quality of services is reported with low scores (percentile 36.79). The correlation analysis showed significant scores (p < 0.00) which indicated the inter-relationship of perceptions of the treatment with staff, elaboration of procedures and confidence in the institution. Conclusions: Factorial aspects of procedures and institutional trust are well evaluated, followed by interaction with staff; through the correlational approach, the general interaction with the staff, of any kind, influences the perception toward others, while confidence in the institution depends on the perception of nurses and formalities.

Resumo Objetivo: Conhecer a perspectiva dos dependentes dos titulares sobre a qualidade do servio de saúde prestado pelo Instituto de Seguridad Social del Estado de México y Municipios (ISSEMyM). Materiais e métodos: Estudo descritivo com a aplica9áo da Escala de Qualidade de Servio recebido pelos Dependentes (ECALDER) para 355 beneficiários com pelo menos um ano de beneficio assistencial nos 10 diferentes centros do Instituto. Resultados: A insatisfação com a qualidade dos servaos é baixa (percentil 36,79). A análise de correlação mostra uma pontuação muito significativa (p <0,00), o que indica a interrelação das percep9oes relacionadas com o atendimento prestado pelas equipes, a elaboração dos tramites e a confiaba na instituição. Conclusoes: A partir de uma análise fatorial, os aspectos relacionados com os tramites e a confiaba na instituto são os melhores avaliados, seguidos da interação com a equipe; correlacionalmente, a interação com as equipes de qualquer área influencia a percepção em relação as outras áreas, enquanto a confiaba na instituto depende da percepção do trabalho dos enfermeiros e procedimentos realizados.

Résumé Objectif: Connaitre la perspective desusagers sur la qualité des services de santé qu'offre "el Instituto de Seguridad Social del Estado de México y Municipios"(ISSEMyM, Institut de Sécurité Sociale de l'État de Mexico et de ses municipalités). Matériels et méthodes: Une étude descriptive a été effectuée sur la base de l'application de «la Escala de Calidad del servicio recibido en Derechohabientes¼ (ECALDER, Échelle de qualité du service re9u par les ayants droit) a 355 usagers qui bénéficiaient des prestations depuis au moins un an dans les 10 différents centres de lInstitut ISSEMyM. Résultats: L'insatisfaction envers la qualité des services est rapportée dans de faibles scores (Percentile 36.79). L'analyse corrélationnelle a montré des effets tres significatifs (p < 0.00) qui indiquent l'interrelation entre les perceptions de l'interaction avec le personnel, la réalisation des démarches administratives et la confiance en l'institution. Conclusions: D'apres l'analyse factorielle, les aspects des démarches administratives et de la confiance en l'institution sont mieux évalués que l'interaction avec le personnel; corrélationnellement, l'interaction avec le personnel de n'importe quelle zone a une influence sur la perception d'autres zones, alors que la confiance en l'institution dépend de la perception du personnel infirmier et des démarches administratives.

Percepção da comunidade quanto à assistência prestada pela equipe de saúde da família / Community perception of the assistance provided by the family health team

Esse estudo foi realizado numa unidade de saúde da família, na cidade de Rondonópolis-MT, utilizando dados a partir de informações contidas por escrito na Caixa de Sugestões e Críticas presente no balcão da recepção da unidade referida. O objetivo do estudo foi conhecer e analisar as percepções da comunidade perante as atividades prestadas pela equipe de saúde da família bem como identificar como esses sentimentos podem influenciar ou intervir no processo de saúde-doença. A pesquisa teve um caráter qualitativo utilizando para análise dos dados o discurso do sujeito coletivo, nos seguintes aspectos, relacionamento usuário versus profissional, atendimento/serviço e condições físicas. Analisando os bilhetes, 76% deles referiu- se ao relacionamento usuário versus profissional. Sendo assim compreendemos que um dos prováveis motivos que mantêm as práticas distanciadas das referências, como par exemplo, a Estratégia de Saúde da Família, seja a relação reprimida e de pouca confidência dos profissionais para com seus clientes.

This study was conducted in the clinic - PSF in the city of Rondonopolis-MT, using data from the information written on box and Suggestions present at the reception desk of the unit above. The objective was to study and analyze the perceptions of the community on activities provided by the team of family health, as well as identify how these feelings can influence ar intervene in the process of health and disease. The study was a qualitative analysis using data of the collective subject discourse, the following aspects, user versus professional relationship, customer service, service and physical conditions. Analyzing the tickets, 76% of them referred to the user versus professional relationship. So we understand that one of the probable reasons that keep the practice apart from references, such as the Health Strategy of the Family, the relationship is repressed and little confidence of professionals to their customers.

Este estudio se realizó en la clínica - fibras discontinuas de poliéster en la ciudad de Rondonópolis, MT, utilizando datos de la información escrita en el cuadro y sugerencias presentes en la recepción de la unidad anterior. El objetivo era estudiar y analizar las opiniones de la comunidad sobre las actividades previstas por el equipo de salud de la familia, así como identificar cómo estos sentimientos pueden influir o intervenir en el proceso de la salud y la enfermedad. El estudio fue un análisis cualitativo a partir de datos del discurso dei sujeto colectivo, los siguientes aspectos, el usuario frente a la relación profesional, servicio ai cliente, servicio y condiciones físicas. Análisis de los billetes de 76% de ellos se refiere ai usuario frente a la relación profesional. Por lo que entendemos que una de las razones probables de que mantener la práctica, aparte de las referencias, tales como la Estrategia de Salud de la Familia, la relación es reprimido y poca confianza de los profesionales a sus clientes.

Validación de la versión reducida del CECASDEP en usuarios de servicios deportivos / Validation of a short version of CECASDEP in sports services users

El objetivo planteado consistió en desarrollar una versión reducida del CECASDEP y obtener evidencias de su validez y fiabilidad en 2 muestras diferentes. Participaron 882 personas con un rango de edad que oscilaba entre 14 y 81 años (M = 34.89; DT = 12.57), de los que 432 eran hombres y 440 mujeres. Se examinó la estructura interna mediante análisis factorial confirmatorio y la validez cruzada mediante análisis multigrupo, obteniendo un buen ajuste en los distintosíndices. El modelo resultante está compuesto por 25 ítems y 5 dimensiones, con propiedades psicométricas que mostraron buena consistencia interna, validez convergente y discriminante. El análisis factorial confirmatorio mostró buen ajuste en los distintosíndices y el análisis multigrupo ofreció una estructura estable en 2 muestras independientes. Los resultados indican que el modelo propuesto supone una herramienta válida para evaluar la calidad percibida en servicios deportivos.

The aim of this study was to develop a short version of CECASDEP and to obtain evidence of its validity and reliability in two different samples. A total of 882 individuals, 432 male and 440 female aged 14 to 81 (M = 34.89; DT = 12.57) were included in the study. Internal structure was examined, using confirmatory factor analysis, and a good adjustment of the model to the data was obtained. Besides, cross-validity was evaluated through multi-group analysis. The resulting model is composed of 25 items and 5 dimensions, with psychometric properties reflecting good internal consistency, convergent validity and discriminant validity. Confirmatory factor analysis showed an acceptable adjustment of the model to the data and multi-group analysis reflected that the structure factor is stable in two independent samples. The results confirm that the proposed model is a valid tool to assess the perceived quality in sports services.